Overview: techniques and indications of LDL-apheresis.

In recent years, LDL-apheresis has emerged to be an efficient treatment of hyperlipidemia in patients who do not respond sufficiently to diet and lipid lowering drugs. A survey of LDL lowering extracorporeal procedures is presented. Among them, to date 5 procedures have been used clinically on a routine basis: unselective plasma exchange, semi-selective double filtration (including its modifications like thermofiltration and predilution/backflush) and three highly selective LDL-apheresis systems: LDL-adsorption on dextran sulfate coated cellulose beads or anti-apoprotein B-linked sepharose and heparin induced extracorporeal LDL and fibrinogen precipitation (the so-called HELP system). Advantages, limitations and special indications of these commercially available systems are discussed. If atherosclerosis can really be made regress by drastic reduction of elevated serum cholesterol levels as indicated by recent publications, lipid apheresis will no doubt play a major role in attaining this goal.

[1]  S. Prigent,et al.  Selective removal of low-density lipoproteins from plasma by polyacrylate-coated Fractogel in vitro and in experimental extracorporeal perfusion. , 1988, Artificial organs.

[2]  V. Hombach,et al.  Treatment of familial hypocholesterolemia by means of specific immunoadsorption , 1988, Journal of clinical apheresis.

[3]  P. Dau,et al.  Treatment of hypercholesterolemia by precipitation of lipoproteins with dextran sulfate , 1988, Journal of clinical apheresis.

[4]  V. Armstrong,et al.  Removal of low‐density lipoproteins (LDL) and fibrinogen by precipitation with heparin at low pH: Clinical application and experience , 1988, Journal of clinical apheresis.

[5]  H. Mabuchi,et al.  A new low density lipoprotein apheresis system using two dextran sulfate cellulose columns in an automated column regenerating unit (LDL continuous apheresis). , 1987, Atherosclerosis.

[6]  V. Hombach,et al.  Regression der Koronarsklerose bei familiärer Hypercholesterinämie IIa durch spezifische LDL-Apherese , 1986, Deutsche medizinische Wochenschrift.

[7]  J. Neaton,et al.  Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). , 1986, JAMA.

[8]  I. Schwaner,et al.  Comparison of plasmafractionation filters and filtration techniques in the clinical practice of LDL-apheresis. , 1986, ASAIO transactions.

[9]  P. Malchesky,et al.  Clinical thermofiltration: initial application. , 1985, Artificial organs.

[10]  S. Yokoyama,et al.  Selective Removal of Low Density Lipoprotein by Plasmapheresis in Familial Hypercholesterolemia , 1985, Arteriosclerosis.

[11]  W. Stoffel,et al.  Selective removal of apolipoprotein B-containing serum lipoproteins from blood plasma. , 1981, Proceedings of the National Academy of Sciences of the United States of America.

[12]  S. Moorjani,et al.  Removal of Cholesterol from Blood by Affinity Binding to Heparin-Agarose: Evaluation on Treatment in Homozygous Familial Hypercholesterolemia , 1980, Pediatric Research.

[13]  S. Moorjani,et al.  A NEW APPROACH TO THE MANAGEMENT OF FAMILIAL HYPERCHOLESTEROLÆMIA: REMOVAL OF PLASMA-CHOLESTEROL BASED ON THE PRINCIPLE OF AFFINITY CHROMATOGRAPHY , 1976, The Lancet.

[14]  M. Malinow,et al.  Removal of plasma cholesterol by adsorption chromatography. , 1975, Atherosclerosis.

[15]  G. Thompson,et al.  PLASMA EXCHANGE IN THE MANAGEMENT OF HOMOZYGOUS FAMILIAL HYPERCHOLESTEROLÆMIA , 1975, The Lancet.